HomeMy WebLinkAboutMortgage_Hardiman P >*a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`,-F t FOR DEDUCTION FROM ASSESSED VALUATION
1"•t'''` l State Form 43709(R12/6-14) �rgr
•• " Prescribed by Department of Local Government Finance
FILED
INSTRUCTIONS: 1.B�Jpo ``
To be filed in person or by mail. APR 1.2 �Il rled with:•
Filing Oates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is MI County Auditor
located on or before January 5 of the immediately succeeding calendar year. . A -. Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the •t- wti'�1h;
where the property is located during the twelve(12)months before March 31 of each year the& *: • yb NTY AUDITOR
See reverse side form,ditional instructions and qualifications.
Applicant(owner or•• tract buyer-see resMctioar rs e p
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T- •n'r t . Key nu giber l legal desal n Red numb, Page number
076 -,/g-/,1-030/-0o/ riot/- oa9 a/
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of ap tion legal or equitable owner?
%.2ia ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone otrier than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r
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UNJ —
Address of mortgagee or contract seller(number an t city,state,and ZIP code)
Name of assignee or other owner or holder of mortg - •
Address of assignee(number and sweet,city,state,and ZIP code) i`fr e,it 1 �r 7/ n/4 i
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested f yes,state amount of deduction
other county on property for
in Indiana? ❑Yes El No current year? El Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
__ — COUNTY AUDITOR -
D
Drawer NO
' 020/1a - 00 ° 20 20 _ 20 20
Si,. Card NO. County - Date(month,day,year)
'oregoing information is true and correct and that the applicant is a resident of Indiana and
__. __.3 application is filed.
r 11� Si.A.4e(� 4(... ft))r lb �� Date(month,day,year)
t�(/\• Full\free/'sident addrreeesss off applicant(number and street,city,state,and Z P code)Jkinti
Person authorized by duly executed Power of AttomeyJo by IC 6-1.1-12-0.7" Date(month,day,year)
Address of authored person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.